Home dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
Authors: Jeffrey Perl, Edwina A. Brown, Christopher T. Chan, Cécile Couchoud, Simon J. Davies, Rümeyza Kazancioğlu, Scott Klarenbach, Adrian Liew, Daniel E. Weiner, Michael Cheung, Michel Jadoul, Wolfgang C. Winkelmayer, Martin E. Wilkie, Alferso C. Abrahams, Samaya J. Anumudu, Joanne M. Bargman, Geraldine Biddle Moore, Peter G. Blake, Natalie Borman, Elaine Bowes, James O. Burton, Agnes Caillette-Beaudoin, Yeoungjee Cho, Brett Cullis, Yael Einbinder, Osama el Shamy, Kevin F. Erickson, Ana E. Figueiredo, Fred Finkelstein, Richard Fluck, Jennifer E. Flythe, James Fotheringham, Masafumi Fukagawa, Eric Goffin, Thomas A. Golper, Rafael Gómez, Vivekanand Jha, David W. Johnson, Talerngsak Kanjanabuch, Yong-Lim Kim, Mark Lambie, Edgar V. Lerma, Robert S. Lockridge, Fiona Loud, Ikuto Masakane, Nicola Matthews, Will McKane, David C. Mendelssohn, Thomas Mettang, Sandip Mitra, Thyago Proença de Moraes, Rachael Morton, Lily Mushahar, Annie-Claire Nadeau-Fredette, K.S. Nayak, Joanna L. Neumann, Grace Ngaruiya, Ikechi Okpechi, Robert R. Quinn, Janani Rangaswami, Yuvaram N.V. Reddy, Brigitte Schiller, Jenny I. Shen, Rukshana Shroff, Maria Fernanda Slon Roblero, Laura Solá, Henning Søndergaard, Isaac Teitelbaum, Karthik Tennankore, Floris Van Ommeslaeghe, Rachael C. Walker, Robert J. Walker, Angela Yee-Moon Wang, Bradley A. Warady, Suzanne Watnick, Eric D. Weinhandl, Caroline M. Wilkie, Jennifer Williams
Journal: Kidney International (2023)

Home dialysis modalities (home hemodialysis [HD] and peritoneal dialysis [PD]) are associated with greater patient autonomy and treatment satisfaction compared with in-center modalities, yet the level of home-dialysis use worldwide is low. Reasons for limited utilization are context-dependent, informed by local resources, dialysis costs, access to healthcare, health system policies, provider bias or preferences, cultural beliefs, individual lifestyle concerns, potential care-partner time, and financial burdens. In May 2021, KDIGO (Kidney Disease: Improving Global Outcomes) convened a controversies conference on home dialysis, focusing on how modality choice and distribution are determined and strategies to expand home-dialysis use. Participants recognized that expanding use of home dialysis within a given health system requires alignment of policy, fiscal resources, organizational structure, provider incentives, and accountability. Clinical outcomes across all dialysis modalities are largely similar, but for specific clinical measures, one modality may have advantages over another. Therefore, choice among available modalities is preference-sensitive, with consideration of quality of life, life goals, clinical characteristics, family or care-partner support, and living environment. Ideally, individuals, their care-partners, and their healthcare teams will employ shared decision-making in assessing initial and subsequent kidney failure treatment options. To meet this goal, iterative, high-quality education and support for healthcare professionals, patients, and care-partners are priorities. Everyone who faces dialysis should have access to home therapy. Facilitating universal access to home dialysis and expanding utilization requires alignment of policy considerations and resources at the dialysis-center level, with clear leadership from informed and motivated clinical teams.